1. Claire McAndrew January 23, 2014 Tobacco Rating: Consumer Concerns and Steps for Advocacy

2. Families USA 2014 ACA allows individual and small group premium surcharge of up to 50% for individuals who use any kind of tobacco: 4 or more times per week, on average Within no longer than the past 6 months, based on when tobacco was last used Does not apply to those under 18 Exception for ceremonial/ religious use What is Tobacco Rating?

3. Families USA 2014 False responses: Insurer can recoup surcharge; can’t rescind policy or deny renewal, etc. Small group: Can only tobacco rate if wellness program is available but individuals do not participate Federal rules are a ceiling, not a floor: States can be more protective Federal Rules (45 CFR 147.102)

4. Families USA 2014 Lack of Evidence Affordability: Credits Don’t Help – John’s premiums would be $600/month. But he smokes. He can be charged: $600 + $300 tobacco surcharge= $900 – Say Jim earns 150% FPL. Premium credits allow him to buy pay $57/ month ($690/ year) for coverage. (4% of income) – With tobacco rating, he has to pay a 50% surcharge on the full premium: – $57 + $300=$357/month (24% of income) Concerns for Consumers

5. Families USA 2014 Smoking by Income (2008)

6. Families USA 2014 Adults with mental illnesses are more likely to smoke cigarettes and less likely to quit than people without mental illnesses. 36 percent of people with mental illnesses smoke, compared with 21 percent of those without mental illnesses. Centers for Disease Control and Prevention, 2013 Tobacco and Mental Health

7. Families USA 2014 Eliminate or Reduce Tobacco Rating – Rating ban: CA, CT, DC, MA, NY, RI, VT – Tobacco rating restriction AR 1.2:1 CO: 1.15:1 KY: 1:4:1 Policy Solutions

8. Families USA 2014 Reduce Look-Back Period for Tobacco Use – Instead of counting tobacco use in last 6 months, count last 3, or last 1, etc. – Increase frequency of tobacco use that defines a tobacco user – Instead of 4 times a week, could define as 6 or 7 times a week on average. Policy Solutions

9. Families USA 2014 Eliminate tobacco rating for those who quit – If someone quits mid-plan year, require premium adjustment – Eliminate tobacco rating for those who enter cessation programs or services – In individual market, eliminate for people who enter cessation programs or services through their insurer, employer, or in the community Policy Solutions

10. Families USA 2014 Information gathering Partner with public health groups (American Cancer Society, tobacco prevention coalitions, etc.) Targets: Insurance commissioner, marketplace board/ director, legislators Federal work: Rules indicate plans for further work on definition of tobacco user; consumer testing on tobacco question: jacob.ackerman@cms.hhs.gov jacob.ackerman@cms.hhs.gov Educate, then advocate! Advocacy

11. Families USA 2014 Contact: Claire McAndrew: cmcandrew@familiesusa.org cmcandrew@familiesusa.org 202-628-3030 Tobacco rating: Issues for Consumers http://familiesusa2.org/assets/pdfs/Tobacco-Rating- Issues-for-Consumers.pdf http://familiesusa2.org/assets/pdfs/Tobacco-Rating- Issues-for-Consumers.pdf Tobacco Rating: State Solutions http://familiesusa2.org/assets/pdfs/Tobacco-Rating- State-Solutions.pdf http://familiesusa2.org/assets/pdfs/Tobacco-Rating- State-Solutions.pdf Further Resources